Eckman v. Moore

Decision Date23 October 2003
Docket NumberNo. 2002-CA-00669-SCT.,2002-CA-00669-SCT.
Parties<I>WALTER W. ECKMAN, M.D. AND AURORA SPINE CENTERS-MISSISSIPPI, INC.</I> <I>v.</I> <I>LINDA MICHELLE MOORE, INDIVIDUALLY, AND FOR AND ON BEHALF OF THE WRONGFUL DEATH BENEFICIARIES OF JASON TAYLOR MOORE, DECEASED</I>
CourtMississippi Supreme Court

ROBERT K. UPCHURCH, DAVID W. UPCHURCH, JOSIAH DENNIS COLEMAN, Attorneys for Appellants.

BOBBY L. DALLAS, BRAD SESSUMS, WALTER C. MORRISON, IV, Attorneys for Appellee.

BEFORE McRAE, P.J., EASLEY AND GRAVES, JJ.

EASLEY, JUSTICE, FOR THE COURT:

STATEMENT OF THE CASE

¶1 This is a wrongful death case involving the medical treatment provided to Jason Taylor Moore (Taylor) by Dr. Walter W. Eckman (Dr. Eckman), the Aurora Spine Centers-Mississippi, Inc. (Aurora), and North Mississippi Medical Center (NMMC).1 On the evening of February 20, 1999, Taylor sustained a head injury by falling in a movie theater and went to NMMC for treatment by the on-call physician, Dr. Eckman. On March 20, 2000, Linda Michelle Moore (Michelle), Taylor's wife, filed suit against Dr. Eckman, Aurora and NMMC both individually and as the conservator of the estate of Taylor in the Circuit Court of Lee County. The complaint alleged personal injury to Taylor and Michelle in connection to the treatment provided to Taylor. On May 19, 2000, Taylor died, and on August 24, 2000, an amended complaint was filed on behalf of Michelle and the wrongful death beneficiaries of Taylor for alleged negligence resulting in the death of Taylor. On February 12-26, 2002, a trial was conducted, and the jury returned a verdict in favor of Michelle and the wrongful death beneficiaries for $5 million. The jury determined that Dr. Eckman and Aurora were 60% liable and NMMC was 40% liable. On March 4, 2002, a final judgment was entered by the trial court. Dr. Eckman and Aurora filed a motion for judgment notwithstanding the verdict, or, in the alternative, a motion for new trial.2 The trial court denied the motion without a hearing. Dr. Eckman and Aurora timely filed their appeal to this Court. This Court affirms the judgment, the jury verdict, and the assessed liability of 60% of Dr. Eckman and Aurora.

FACTS

¶2 While at the movies, Taylor went to the bathroom and apparently slipped or fell and struck his head. He wandered out of the theater and drove away in his car. Michelle, Taylor's wife, could not find him and called him on his cellphone. Taylor seemed confused, but she eventually had Taylor go to the emergency room. Dr. Peters in the emergency room ordered a computer tomography, a.k.a. CT or cat scan, to be performed on Taylor on February 20. The CT scan showed some bleeding in the frontal lobe. Neurological checks and vital signs were ordered every two hours.

¶3 According to the testimony of Dr. Hauser, expert witness for Michelle, during the course of the day a number of significant changes occurred to Taylor, such as nausea, increasing headaches, and later increased blood pressure. Around 1:50 p.m. the medical records indicated that Dr. Eckman ordered Talwin, a potent narcotic for pain relief, and increased the Codeine dosage from 30 milligrams up to 60 milligrams and up to 90 milligrams. According to Dr. Hauser, Talwin is more sedating than Codeine and typically avoided in head injury cases. Codeine, on the other hand, is less sedating and used to follow a patient's mental status. Even though Codeine is less sedating, Dr. Hauser testified that it should be avoided if possible. In addition, Dr. Hauser testified that Talwin has the potential for suppression of mental status in head injury patients, obscuring the clinical course for head injuries. Further, Talwin may suppress a patient's respiration which may directly increase intracranial pressure. Dr. Hauser testified that at this time, approximately 2:00 p.m., that Dr. Eckman should have gone to see Taylor, performed a detailed neurological examination and performed another CT scan. Dr. Hauser testified that in his opinion, Dr. Eckman fell below the standard of care by failing to perform these tasks.

¶4 About 2:00 p.m. Taylor began to complain of nausea and headaches even though he had increased pain medication. Dr. Hauser testified that both these complaints along with increased blood pressure were significant. Taylor had been diagnosed with hypertension a few years before and took medication for the condition. At 6:00 p.m. his blood pressure was 150/98, which Dr. Hauser considered "worrisome" and at 170/110 two hours later. The increased blood pressure in a patient with a known head injury is "suspicious" and may indicate a progression of intracranial hypertension. The nurses informed Dr. Eckman about the increased blood pressure and he told the nurses to give Taylor his blood pressure medicine. At this point, approximately 6:00 p.m., and in light of Taylor's increased blood pressure, having a known head injury with intracranial bleeding and increased headaches and needing increased pain medication, Dr. Hauser testified that Dr. Eckman fell below the standard of care. Dr. Hauser stated that Dr. Eckman should have examined Taylor and ordered another CT scan, which would have shown a subdural hematoma.

¶5 Taylor was given Monopril, his usual blood pressure medicine, just before 7:00 p.m. Instead of lowering his blood pressure, the medical records indicated that his blood pressure increased. By 8 p.m. Taylor's blood pressure was 170/110, and two hours later it was 172/124. Dr. Hauser believed that the increase in blood pressure was an indication of increased pressure in Taylor's head. The records indicated that around 10:30 p.m. the nurses notified Dr. Eckman that Taylor had what he described as the worst headache that he's ever had and of Taylor's increased blood pressure. Dr. Hauser testified that a patient complaining of the worst headache that he ever had; needing increased pain medication; and increasing hypertension, despite taking blood pressure medication, is an indication of increased pressure in the head. Dr. Eckman ordered that the Talwin and Codeine be given alternately and the check of vital signs should be decreased from every two hours to every four hours. Again, Dr. Hauser testified that Dr. Eckman fell below the standard of care and should have examined Taylor, ordered a CT scan and presumably seen the subdural hematoma, and surgically drained the area. In addition, Dr. Hauser testified that had the CT scan and surgery been performed then Taylor would not have suffered from a brain herniation, there would have been little or no further damage from the pressure in his head and he would have survived and been normal.

¶6 On cross-examination Dr. Hauser stated that from Taylor's initial admission at 11:00 p.m. Saturday night to 10:00 p.m. Sunday, there was no decline in his Glasgow Coma Score or his neurological status. A normal neurological check includes waking a patient from sleep and checking their level of consciousness, pupils, speech, orientation to person, place and time, and strength. Dr. Hauser opined that the nursing staff performed appropriate neurological assessments from Taylor's presentation to the emergency room at 10:30 p.m. on February 20 through approximately 10:30 p.m. on February 21. Dr. Hauser stated that there were no documented neurological checks performed by the nursing staff between 10:00 p.m. and 6:00 a.m. (February 21-22) that sufficiently complied with the standard of care for nurses. Dr. Hauser stated that had the neurological checks been adequately performed by the nursing staff then Taylor's changes would have been discovered, the doctor could have been called and provided surgical care, the arrest and brain damage would have been avoided, and his death would have been prevented as well. The hematoma accumulated over a 30-hour period.

¶7 When Dr. Eckman was contacted by the staff, he gave no orders for surgery but, ordered a CT scan. Around noon, an angiogram was ordered, and it indicated that the blood supply to the brain was intact. Dr. Hauser testified that in his opinion Dr. Eckman failed to comply with the standard of care on February 22 by failing to operate on the hematoma. There was some apparent controversy between Dr. Eckman, claiming that he recommended surgery, and Taylor's family concerning the decision not to operate on Taylor at that time. Despite this controversy, Dr. Hauser testified that he disagreed with the information provided by Dr. Eckman to Taylor's family. Dr. Eckman allegedly stated that Taylor was essentially brain dead and that an operation would not help the situation. Dr. Hauser considered the presentation of the information to be a deviation of standard of care. Instead, Dr. Hauser testified that he would have performed the surgery on Taylor. According to Dr. Hauser, had an operation been performed shortly after taking the CT scan on February 22 and removed the clot, then Taylor likely would not have suffered massive brain damage and his later death. An operation was performed on February 23.

¶8 Dr. Eckman stated that he requested that the emergency room physician admit Taylor to the hospital about 2:00 a.m. and to make a written request for the neurological checks on him. Dr. Eckman then saw Taylor about 7:00 or 8:00 a.m that same morning. During the visit Dr. Eckman collected Taylor's medical history, performed a general physical exam, and a detailed neurological exam. Other than suffering from a headache, Taylor appeared to be in normal condition. The next time that Dr. Eckman saw Taylor was after his arrest. Prior to the arrest, Dr. Eckman had a few telephone conversations with the hospital staff about Taylor's condition. Dr. Eckman stated that prior to the arrest, he had not heard from the nursing staff since about 10:00 to 10:30 p.m. the previous night.

DISCUSSION

I. Whether the trial court erred by...

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